Provider Demographics
NPI:1417915844
Name:SIDDIQUI, NADEEM (MD)
Entity Type:Individual
Prefix:
First Name:NADEEM
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:4701 OLD SHEPARD PL STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5295
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6992
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7183207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL7183OtherMEDICAL LICENSE
TXG52018Medicare UPIN
TX8A9257Medicare PIN
TXP00054447Medicare PIN